LECTURE 10: SPECIAL COLLECTIONS AND POINT-OF-CARE TESTING
MT 103 | Principles of Medical Laboratory Science 2
INTRODUCTION
● Collecting specimens for special tests
requires special preparation, equipment,
handling, or timing.
● POCT specimens are collected using small,
portable, and often handheld testing devices
that bring laboratory testing to the location of
the patient.
● POCT is convenient for the patient; its short
turnaround times (TATs) for results allow
healthcare providers to address crucial
patient needs, deliver prompt medical
attention, and expedite patient recovery.
VENIPUNCTURE
is the process of collecting or “drawing” blood from
a vein and the most common way to collect blood
specimens for laboratory testing.
The most important step in this procedure is
patient identification.
SPECIAL PROCEDURES
● Most laboratory tests require blood specimens
that are collected by routine venipuncture or
capillary puncture procedures.
● Some tests, however, require special or
additional collection procedures or are
performed on other body substances such
as feces or urine.
● Collecting specimens for these tests may
require special preparation, equipment,
handling, or timing.
● Most commonly encounters special test
procedures:
➢ Blood Bank Specimens
➢ Type, Screen, and Crossmatch
➢ Blood Donor Collection
➢ Blood Culture
➢ Antimicrobial Neutralization
➢ Coagulation Specimens
➢ 2-Hour Postprandial Glucose
➢ Glucose Tolerance Test
BSMT 1D - VILLAMALA, ACR
➢ Paternity/Parentage Testing
➢ Therapeutic Drug Monitoring
➢ Therapeutic Phlebotomy
➢ Toxicology Specimens
➢ Trace Elements
BLOOD BANK SPECIMENS
● Blood bank specimens yield information that
determines which blood products can be
transfused safely into a patient.
● Faithful attention to protocol in collecting blood
bank specimens is crucial to safe transfusions.
Specimen Requirements
❖ Blood bank tests require the collection of
one or more lavender- or pink-top EDTA
tubes.
❖ In some cases, a nonadditive glass
red-stoppered tube is used.
Identification and Labeling Requirements
❖ Blood bank specimens require strict patient
identification and specimen labeling
procedures.
❖ Specimens that have labeling errors of any
kind or are unlabeled will not be accepted
for testing
❖ An error in specimen identification or
labeling requires re-collection of the
specimen and causes a delay in patient
treatment.
❖ An undetected error can result in
administration of an incompatible blood
product and the possibility of a fatal
transfusion reaction.
Special Identification Systems
❖ A variety of special blood bank identification
systems are available.
❖ One system uses a special ID bracelet such
as the PDC Securline Blood Bank
(Precision Dynamics Corporation, San
Fernando, CA), which is attached to the
patient’s wrist.
 ❖ With this system, the patient’s identity is ● When required, a cross-match is performed
confirmed and the information written on a using the patient’s type and screen results to
self-carbon adhesive label on the special help select a donor unit of blood.
bracelet, which contains a unique ID ● During a cross-match, the patient’s plasma or
number. serum and the donor’s RBCs are mixed
❖ The adhesive label is peeled from the together to determine compatibility (suitability
latex-free bracelet, leaving a carbon copy of to be mixed).
the information, including the unique ID ● A transfusion of incompatible blood can be
number, on the bracelet. fatal because of agglutination (clumping) and
lysis (rupturing) of the RBCs within the
LABELING REQUIREMENTS FOR patient’s circulatory system.
BLOOD BANK SPECIMENS
1. Patient’s full name (including middle initial)
2. Patient’s hospital identification number (or
social security number for outpatients)
3. Patient’s date of birth
4. Date and time of collection
5. Phlebotomist’s initials
6. Room number and bed number (optional)

❖ Additional ID-number labels from the

bracelet are sent to the lab with the
specimen to be used in the cross-match
process or eventually attached to the unit of
blood or other blood products used for
transfusion.
Blood Type Compatibility Chart
❖ Prior to transfusion, the nurse must match
the numbers on the patient’s blood bank
ID bracelet with the numbers on the unit
of blood.
❖ Some facilities require the unique number
and patient’s name to be brought to the
blood bank as an additional identification
check when the blood products are being
picked up.
❖ In recent years, blood ID-band systems with
linear bar-coded BBID numbers have been
introduced for use.
❖ Both of these systems allow for the
implementation of electronic blood bank ID
systems.

TYPE, SCREEN, AND CROSS-MATCH

● One of the most common tests performed by
the blood bank is a blood type and screen
● This test determines a patient’s blood type
(ABO) and Rh factor (positive or negative).

● Universal Donor: O- Blood Type
● Universal Recipient: AB+ Blood Type
Autologous Donation
BLOOD DONOR COLLECTION
● Blood donor collection involves collecting
blood to be used for transfusion purposes
rather than for diagnostic testing.
● Blood is collected from volunteers in amounts
referred to as units
● Donor collection requires special training and
exceptional venipuncture skills.
● Facilities that provide blood products for
transfusion purposes are called Donor Blood
Banks.
● Blood banks follow guidelines set by the
American Association of Blood Banks (AABB)
for purposes of quality assurance and
standardization.
● Regulation by the U.S. Food and Drug
Administration (FDA) is required, since blood
and blood products are considered
pharmaceuticals.
● KEY POINT: All potential blood donors must
be interviewed to determine their eligibility to
donate blood as well as to obtain information
for the records that must be kept on all blood
donors.
Specimen Requirements
RED, LAVENDER, PINK
Labeling Requirements
Complete name of patient
Date and time of collection
Age and sex of patient
Phlebotomist’s initials
Birthday of patient
Special Identification System
Typenex and Secureline
● Special bracelet that contains a unique ID
number
● Patient’s ID information written on
self-carbon adhesive label
● Label peeled from bracelet and placed on
specimen tube
● Additional ID numbers sent to lab to be
attached to unit of blood
❖ Despite advances in preventing the
transmission of infection through
transfusions, providing safe blood for blood
products remains a challenge.
❖ Errors such as drawing blood samples from
the wrong patient for blood transfusion
present even more of a risk than
transmissible diseases.
❖ Autologous donation is the process by
which a person donates blood for his or her
own use.
❖ This is done for elective surgeries when it is
anticipated that a transfusion will be needed
❖ Using one’s own blood eliminates many
risks associated with transfusion, such as
disease transmission and blood or plasma
incompatibilities.
❖ Although blood is normally collected several
weeks prior to the scheduled surgery, the
minimum time between donation and
surgery can be as little as 72 hours.
❖ To be eligible to make an autologous
donation, a person must have a written
order from a physician.
THINGS TO KNOW:
The anticoagulant and preservative CPD
(citrate–phosphate–dextrose) or CPDA1 (CPD
plus adenine) is typically used in collecting
units of blood for transfusion purposes.
PRINCIPLES OF DONOR UNIT COLLECTION
1. Donor units are normally collected from a
large antecubital vein.
2. The vein is selected in a manner similar to

routine venipuncture and cleaned in a
manner similar to blood culture collection
3. The collection unit is a sterile, closed system
consisting of a bag to contain the blood
connected by a length of tubing to a sterile
16- to 18-gauge needle.
4. The bag fills by gravity and must be placed
lower than the patient’s arm.
5. The collection bag contains an anticoagulant
and preservative solution and is placed on a
mixing unit while the blood is being drawn.
6. The unit is normally filled by weight but
typically contains around 450 mL of blood
when full. Only one needle puncture can be
used to fill a unit. If the unit only partially fills
and the procedure must be repeated, an
entire new unit must be used.
Cell Salvaging
❖ Aqueous solutions, plasma, and serum
samples or banked erythrocytes often
contain lysed RBCs that have released
hemoglobin into the solution.
❖ For example, during some surgical
procedures, the patient’s blood is salvaged,
washed, and reinfused.
❖ Prior to reinfusion, it is recommended that
the salvaged blood be tested for residual
free hemoglobin.
❖ A high free hemoglobin level indicates that
too many red cells were destroyed during
the salvage process and renal dysfunction
could result if the blood were reinfused.
❖ Free hemoglobin can be detected using
point-of-care instruments such as the
HemoCue Plasma/Low Hemoglobin
analyzer
BLOOD CULTURES
● It is known that bacteria can enter the body
and cause disease
What’s the difference between
Bacteremia and Septicemia?
During the disease process, bacteria may also
enter the circulatory system, causing bacteremia
(bacteria in the blood) or septicemia
(microorganisms or their toxins in the blood)
● Except when overwhelming infection is
present, these organisms are generally cleared
from the bloodstream in a short time.
● Blood cultures help determine the presence
and extent of infection as well as indicating the
type of organism responsible and the antibiotic
to which it is most susceptible.
● They are also useful in assessing the
effectiveness of antibiotic therapy once
treatment is initiated.
● Blood cultures should be ordered on the basis
of whether the patient has a condition in which
bloodstream invasion is possible and not only
when a patient experiences a fever of
unknown origin (FUO). Some elderly patients
and others with underlying conditions are often
not capable of mounting good fever responses,
even though they may be experiencing
septicemia.
Timing For Blood Culture Drawing
❖ Blood Cultures are typically ordered
immediately before or after anticipated fever
spikes when bacteria are likely to be
present.
❖ Timely collection is essential
❖ The best chance for detecting bacteremia
exists from ½ hour to 2 ½ hours prior to the
next fever peak
❖ Usually two specimens are drawn 30-60
minutes apart from two different sites.
Blood Culture Volume
❖ Depending upon the blood culture system
❖ 10 ml is usually the minimum volume
❖ According to ASM, the volume of blood
drawn for infants and younger children
should be from 1% to 4% of the patient’s
total blood volume, generally speaking.
❖ For adults or people weighing more than 80
pounds, the recommended volumes for
blood cultures are 20 to 30 mL per culture
with a minimum of 10 mL per draw.
❖ Blood cultures should not be drawn
through an indwelling IV or arterial
catheter unless absolutely necessary.
❖ Draws from vascular lines are known to
have a high contamination rate and may
 cause a person to receive antibiotic therapy
when a septic condition is not truly present.
Other types of Antiseptic for Blood Culture
❖ 10% povidone or 1-2% tincture of iodine
❖ Benzalkonium chloride
❖ Chlorhexidine gluconate or isopropyl alcohol
➢ Chlorhexidine gluconate is the
recommended blood culture site
disinfectant for infants 2 months
and older and patients with iodine
sensitivity.
Skin Antisepsis
❖ The major difficulty in the interpretation of
blood cultures is contamination by microbial
flora on the skin.
❖ Skin antisepsis, the destruction of
microorganisms on the skin, is a critical
part of the blood culture collection
procedure.
❖ Failure to carefully disinfect the
venipuncture site can:
➢ introduce skin-surface bacteria into
the blood culture bottles
➢ interfere with interpretation of
results.
❖ The laboratory must report all
microorganisms detected; it is then up to the
patient’s physician to determine whether the
organism is clinically significant or merely a
contaminant.
❖ If a contaminating organism is
misinterpreted as pathogenic, it could result
in inappropriate treatment.
❖ This problem is overcome best by
meticulous preparation of the skin with a
bactericidal agent.
❖ Antiseptic or sterile technique for blood
culture collection varies slightly from one
laboratory to another.
➢ To minimize the risk of
contamination by skin flora, the
collection sites require a 30- to
60-second friction scrub to get to
the bacteria beneath the dead skin
cells onto the surface of the arm.
❖ FIRST CLEANSE:
➢ 70% isopropyl alcohol, 30 seconds
scrub
❖ SECOND CLEANSE:
➢ 1% to 2% tincture iodine, 30 second
scrub
➢ Povidone swabstick, 60 seconds
➢ Scrub concentric circles
❖ TREAT GLOVED FINGER THE SAME
Antimicrobial Neutralization Products
● To be used to remove antimicrobial therapy
present in patients blood
● It is not unusual for patients to be on
antimicrobial (antibiotic) therapy at the time
blood culture specimens are collected
● Presence of the antimicrobial agent in the
patient’s blood can inhibit the growth of the
microorganisms in the blood culture bottle.
● In such cases, the physician may order
blood cultures to be collected in fastidious
antimicrobial neutralization (FAN) or
antimicrobial removal device (ARD)
bottles.
○ ARD contains a resin that removes
antimicrobials from the blood.
○ FAN bottles contain activated
charcoal, which neutralizes the
antibiotic
● The blood can then be processed by
conventional technique without the risk of
inhibiting the growth of microorganisms.
● ARDs and FANs should be delivered to the
lab for processing as soon as possible.
Specimen Requirements
● The most recent literature of the American
Society for Microbiology (ASM) states that
two to four blood cultures are necessary to
optimize the detection of bacteremia and
fungemia.
● For optimum results, such specimens should
be drawn 30 to 60 minutes apart.
● However, if the patient is in critical condition
or an antibiotic must be given right away,
cultures should be drawn consecutively and
immediately from different sites.
● When more than one set is ordered for
collection at the same time, the second set
should be obtained from a separately
prepared site on the opposite arm if
 ➢ SPS in the collection tube when
possible.
● In some cases, “second-site” blood cultures added to the blood culture bottle
are more useful when drawn 30 minutes increases the final concentration of
apart. SPS.
● If timing is not specified on the requisition, ➢ Transfer of blood from the
the phlebotomist should follow the laboratory intermediate tube to the blood
protocol. culture bottles presents another
opportunity for contamination.
Tincture of iodine, ➢ Transfer of blood to the culture
chlorhexidine gluconate, bottles presents an exposure risk to
and a povidone/70% ethyl laboratory staff.
alcohol combination have
all been shown to be COAGULATION SPECIMENS
effective. ● There are a number of important things to
remember in collecting specimens for
❖ Traditionally 10% povidone or 1% to 2% coagulation tests.
tincture of iodine compounds in the form of ○ At one time it was customary to draw a
swab sticks or special cleaning-pad kits “clear” or discard tube prior to collection
such as benzalkonium chloride have been of a blue-top tube. A few milliliters of
used to clean the collection site. blood were collected into a plain red-top
❖ In using a povidone–iodine or chlorhexidine tube to clear the needle of
gluconate ampule swab, the swab should thromboplastin contamination picked up
be placed at the site of needle insertion as it penetrated the skin. The clearing
and moved outward in concentric circles tube was discarded if it was not needed
without going over any area more than for other tests. New studies have shown
once. The area covered should be 3 to 4 in. that a clear tube is not necessary
in diameter. when collecting for a PT or PTT. A
❖ Because of the increasing incidence of clear tube is required for all other
iodine sensitivities, some healthcare coagulation tests (e.g., factor VIII)
facilities are using chlorhexidine because the CLSI still recommends that
gluconate/isopropyl alcohol antiseptic they be the second or third tube drawn.
preparations in blood culture preparation ○ Sodium citrate tubes for coagulation
kits that have a one-step application and are studies must be filled until the vacuum is
effective with a 30-second scrub. exhausted to obtain a 9:1 ratio of blood
to anticoagulant. Even when the tubes
Intermediate Collection Tube
are properly filled, this ratio is altered if
❖ Blood is sometimes
the patient’s hemoglobin level is
collected in an intermediate
abnormally high or low. In such cases,
collection tube rather than
laboratory personnel may request
blood culture bottles.
specimen collection in a special tube
❖ A yellow-top sodium
that has had the anticoagulant volume
polyanethol sulfonate
adjusted. A blue-top CTAD tube is
(SPS) tube is acceptable for this purpose.
available for special coagulation testing.
❖ Other anticoagulants—such as citrate,
In addition to sodium citrate, CTAD
heparin, EDTA, and oxalate—may be toxic
tubes contain theophylline, adenosine
to bacteria and are not recommended.
and dipyridamole to inhibit thrombocyte
❖ Use of an intermediate tube is discouraged,
however, for the following reasons:
 activation between collection of the decreased, respectively, leading to
blood and performance of the test. misinterpretation of results.
○ CAUTION: All anticoagulant tubes must
be gently inverted three or four times Purpose
immediately after collection to avoid A. Screen for presence of diabetes
microclots, which can invalidate test B. Monitor effects of insulin dosage in
results. diagnosed diabetes.
○ Never pour two partially filled tubes Fasting required: beginning at midnight until
together to create a full tube, as the breakfast
anticoagulant-to-blood ratio will be A. Breakfast: Patient consumes a prescribed
greatly increased. meal containing 100 grams of
○ Cooling on ice during transport may be carbohydrates
B. Blood specimen collected 2 hours after
required for some test specimens to
consumption
protect the coagulation factors. Some
coagulation factors, such as factors V Nondiabetic patient: Glucose returns to normal
and VIII, are not stable. If the tests within 1 1/2 to 2 hours
cannot be performed in a timely manner,
the specimen must be centrifuged and PRINCIPLES OF 2-HOUR PP SPECIMEN
the plasma frozen. COLLECTION
○ If a coagulation specimen must be
1. The patient is placed on a
drawn from an indwelling catheter, the
high-carbohydrate diet for 2 to 3 days
CLSI recommends drawing and
prior to the test.
discarding 5 mL of blood or six times
2. The patient fasts prior to the test. This
the dead-space volume of the catheter
means no eating, smoking, or drinking other
before collecting the specimen. If
than water for at least 10 hours before the
heparin has been introduced into the
test.
line, it should be flushed with 5 mL of
3. A fasting glucose specimen may be
saline before drawing the discard blood
collected before the start of the test.
and collecting the specimen.
4. The patient is instructed to eat a special
breakfast (typically one containing the
2-HOUR POSTPRANDIAL GLUCOSE
equivalent of 100 grams of glucose) or
● Postprandial (PP) means after a meal.
given a measured dose of glucose beverage
● Glucose levels in blood specimens obtained 2
on the day of the test.
hours after a meal are rarely elevated in
5. A blood glucose specimen is collected 2
normal persons but may be significantly
hours after the patient finishes eating
increased in diabetic patients.
● Therefore a glucose test on a specimen
collected 2 hours after a meal (2-hour PP) is
an excellent screening test for diabetes and
other metabolic problems.
● A 2-hour PP test is also used to monitor insulin
therapy.
● Correct timing of specimen collection is very
important.
● Glucose levels in specimens collected too
early or late may be falsely elevated or
 GLUCOSE TOLERANCE TEST
● A glucose tolerance test (GTT) is used to
diagnose problems of carbohydrate
metabolism. The major carbohydrate in the
blood is glucose, the body’s source of energy.
● The GTT, also called the oral glucose test
(OGTT), evaluates the body’s ability to
metabolize glucose by monitoring the patient’s
tolerance to high levels of glucose without
adverse effects.
● Provides more detailed information on glucose
utilization
● Assesses insulin response to glucose load
● Used to diagnose:
○ Diabetes mellitus
○ Hypoglycemia
○ Liver and adrenocortical dysfunction
GTT Preparation and Procedure
1. Preparation for a GTT is very important.
2. The patient must eat balanced meals
containing approximately 150 grams (g) of
carbohydrate for 3 days before the test
and must fast for at least 12 hours but not
more than 16 hours prior to the test.
3. The patient is allowed to drink water during
the fast and during the test to avoid
dehydration and because urine specimens
may be collected as part of the procedure.
4. No other foods or beverages are allowed.
5. The patient is also not allowed to smoke or
chew gum, as these activities stimulate the
digestive process and may cause erroneous
test results.
6. The patient should receive both verbal and
written instructions to ensure compliance
LACTOSE TOLERANCE TEST
● A lactose tolerance test is used to determine
if a patient lacks the enzyme (mucosal lactase)
that is necessary to convert lactose, or milk
sugar, into glucose and galactose.
● A lactose tolerance test is typically performed
in the same manner as a 2-hour GTT;
however, an equal amount of lactose is
substituted for the glucose.
● Blood samples are drawn at the same times as
for a GTT. If the patient has mucosal lactase,
the resulting glucose curve will be similar to a
GTT curve, and the result is considered
negative. If the patient is lactose intolerant
(lacking the enzyme lactase), the glucose
curve will be flat, rising no more than a few
mg/dL from the fasting level.
● Some individuals normally have a flat GTT
curve (resulting in a false-positive result); it is
then suggested that they have a 2-hour GTT
performed the day before the lactose tolerance
test so that results can be evaluated
adequately.
● False-positive results have also been
demonstrated in patients with small bowel
resections and with disorders such as slow
gastric emptying, Crohn’s disease, and cystic
fibrosis. A lactose tolerance test can also be
performed on breath samples
 PATERNITY/PARENTAGE TESTING
● Paternity testing is performed to determine
the probability that a specific individual
fathered a particular child. Generally, paternity
test results exclude the possibility of paternity
rather than prove paternity.
● Testing may be requested by physicians,
lawyers, child support enforcement bureaus, or
individuals. Paternity testing requires a
chain-of-custody protocol and specific
identification procedures that may include
fingerprinting.
● A photo identification document such as a
passport is usually required.
● The mother, child, and alleged father are all
tested. Blood samples are preferred for testing;
however, buccal (cheek) swabs are
increasingly being used.
● Blood sample testing usually includes ABO
and Rh typing. If the putative (assumed) or
alleged parent is not excluded by basic red cell
antigen testing, further testing is performed
until the individual is excluded or the likelihood
of parentage is established. Further testing
includes identifying extended red cell antigens,
red cell enzymes and serum proteins, white
cell enzymes, and HLA (human leukocyte
antigen), or white cell antigens.
● Buccal samples are collected by rubbing a
swab against the inside of the cheek to collect
loose cells. DNA extracted from the cells is
“mapped” to create a DNA profile. DNA profiles
of the individuals involved are compared to
determine an alleged father’s probability of
paternity
● Paternity testing can also be performed before
the infant is born on specimens obtained by
amniocentesis or by chorionic villus
sampling. (Chorionic villi are projections of
vascular tissue that have the same genetic
makeup as the fertilized egg and become the
fetal portion of the placenta.)
THERAPEUTIC DRUG MONITORING
● Therapeutic drug dosage necessary to
produce a desired effect varies widely among
patients and may require oversight.
● Therapeutic drug monitoring (TDM), the
testing of drug levels at specific intervals, is
used in the management of patients being
treated with certain drugs in order to help
establish a drug dosage, maintain the dosage
at a therapeutic (beneficial) level, and avoid
drug toxicity.
● For a drug to be beneficial, the peak
(maximum) level must not exceed toxic
levels, and the trough (minimum) level must
remain within the therapeutic range.
THERAPEUTIC PHLEBOTOMY
● Therapeutic phlebotomy involves the
withdrawal of large volumes of blood usually
measured by the unit (as in blood donation), or
approximately 500 mL. It is used as a
treatment for certain medical conditions such
as polycythemia and hemochromatosis.
● It is performed by phlebotomists who have
been specially trained in the procedure or in
donor phlebotomy, as the procedure is similar
to collecting blood from donors.
● It is used as a treatment for certain medical
conditions such as polycythemia and
hemochromatosis.
○ Polycythemia is a disease involving the
body’s overproduction of RBCs, which is
detrimental to the patient’s health and
the most common reason for performing
therapeutic phlebotomy. The patient’s
RBC levels are monitored regularly,
usually by the hematocrit test. Periodic
removal of blood when the hematocrit
exceeds a certain level is used to help
keep the patient’s RBC levels within the
normal range.
○ Hemochromatosis is a disease
characterized by excess iron deposits in
the tissues. It can be caused by a defect
in iron metabolism or result from multiple
blood transfusions or excess iron intake.
Periodic removal of single units of blood
from the patient gradually depletes iron
stores, because the body then uses the
iron to make new RBCs to replace those
removed.
 TOXICOLOGY SPECIMENS
● Toxicology is the scientific study of toxins
(poisons).
○ Clinical toxicology is concerned with
the detection of toxins and treatment for
the effects they produce.
○ Forensic toxicology is concerned with
the legal consequences of toxin
exposure, both intentional and
accidental.
● Toxicology tests examine blood, hair, urine,
and other body substances for the presence of
toxins, which often exist in very small amounts.
Forensic Specimens
❖ Increasingly law enforcement officials
request the collection of a toxicology
specimen for forensic or legal reasons.
❖ The tests most frequently requested are
breath or blood for alcohol.
❖ Other requests include urine drug screens
and blood specimens for drugs and DNA
analysis.
❖ When forensic specimens are collected, a
special protocol, referred to as the chain of
custody, must be strictly followed.
❖ Chain of custody requires detailed
documentation that tracks the specimen
from the time it is collected until the results
are reported.
❖ The specimen must be accounted for at all
times. If documentation is incomplete, legal
action may be compromised.
❖ One example of a chain-of-custody form is
used to identify the specimen and the
person or persons who obtained and
processed it.
❖ Information on the form also includes the
time, date, and place where the specimen
was obtained, along with the signature of
the person from whom the specimen was
taken.
❖ Patient identification and specimen
collection take place in the presence of a
witness, frequently a law enforcement
officer, in which case protocol and
packaging are completed by the officer
before the specimen is sent to a crime
laboratory for analysis. Any person who is
involved in drawing a blood alcohol
specimen for legal reasons can be
summoned to appear in court.
DRUG SCREENING
● Many healthcare organizations, sports
associations, and major companies require
pre-employment drug screening. Random
screening (without prior notice) may be
performed on employees or athletes.
● Tests may detect a specific drug or screen for
up to 30 different drugs, depending upon the
circumstance.
● Testing is typically performed on urine rather
than blood because it is easy to obtain and a
wide variety of drugs or their metabolites
(products of metabolism) can be detected in
urine for a longer period of time.
● The Triage TOX Drug Screen device (Biosite
Incorporated, San Diego, CA) can rapidly and
simultaneously test for seven major classes of
drugs of abuse.
● Illicit drugs detected include cocaine (crack),
opiates (heroin), and amphetamines (ecstasy,
speed, crystal), and tetrahydrocannabinol
(pot).
● There are legal implications to drug screening,
and a chain-of-custody protocol is required
whether or not the test is being performed for
legal reasons. The following are urine drug
screen patient preparation and collection
requirements defined by the National Institute
on Drug Abuse (NIDA)
Patient Preparation Requirements since the amounts being tested are in micro- or
❖ Explain the test purpose and procedure. nanograms.
❖ Advise the patient of his or her legal rights. ● Contaminants in the stoppers accumulate in
❖ Obtain a witnessed, signed consent form. the needle each time a different tube is pierced
in a multiple-tube collection. That accumulation
Specimen Collection Requirements can then carry over to the royal blue-stoppered
❖ A special area must be maintained for urine tube, changing the results. When a
collection. trace-element test is ordered, it is best to draw
❖ A proctor is required to be present at the it by itself if using a needle/tube assembly, or a
time of collection to verify that the specimen syringe may be used.
came from the correct person. ● For best results, change the transfer device
❖ A split sample may be required for before filling the royal-blue tube.
confirmation or parallel testing.
❖ The specimen must be labeled
appropriately to establish a chain of
custody.
❖ To avoid tampering, a specimen must be
sealed and placed in a locked container
during transport from the collection site to
the testing site. Documentation must be
carefully maintained from courier to
receiver.

TRACE ELEMENTS
● Trace elements or metals include aluminum,
arsenic, copper, lead, iron, and zinc.
● These elements are measured in such small
amounts that traces of them in the glass,
plastic, or stopper material of evacuated tubes
may leach into the specimen, causing falsely
elevated test values.
● For this reason, specimens for these tests
must be collected in special trace element-free
tubes. These tubes are made of materials that
have been specially manufactured to be as
free of trace elements as possible.
● An insert with each carton of tubes gives a
detailed analysis of residual amounts of metals
contained in the tubes. These tubes are
typically royal blue and contain EDTA, heparin,
or no additive.
○ The type of additive is indicated on
the label (e.g., red for no additive,
lavender for EDTA, and green for
heparin).
● In collecting trace elements, it is important to
prevent introducing even the smallest amount
of the contaminating substance into the tube,